Provider Demographics
NPI:1851491559
Name:LARSON, THOMAS CHARLES (MS)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CHARLES
Last Name:LARSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-0730
Mailing Address - Country:US
Mailing Address - Phone:760-773-6767
Mailing Address - Fax:760-773-6760
Practice Address - Street 1:14320 PALM DR
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-6874
Practice Address - Country:US
Practice Address - Phone:760-773-6767
Practice Address - Fax:760-773-6760
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43840106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist